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William C. Altreuter
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Thursday, March 24, 2005

Damnit, I really want to stop reading and thinking about the Terri Schiavo matter, but it keeps dragging me back in. Part of my problem, I think, is that over the years I have handled matters dealing with the question of consciousness, and so have no patience with the people who assert that the evidence that this is a person is in a persistant vegitative state is somehow equivocal. One case in particular will stay with me for the rest of my life: a young man who accidentally shot out his prefrontal lobe horsing around with a handgun. For all I know his body is still being maintained in a hospital, but there was no awareness according to the medical proof at the time. Oliver Sacks actually consulted on that one, a brush with genius for me.

I've seen other cases like this: typically the person doesn't last all that long, but a month, or three months, or whatever is long enough. It is the survivors that experience the suffering: reaction to sensation in the patent, or even random movement or sound can ignite an ember of hope, so that the husband or wife or mother or father is forced to re-experience the horror of their loved ones' injury again and again. I get to hear the testimony about all this, and it brings me no joy; I am as inclined to live in optimistic denial as anyone else, and can understand why these people would want to believe that the breathing shell that they sat next to was still the person that they loved. I don't deal in the questions about maintaining life support; I come in long after, when the survivor's grief has calcified into anger.

Timothy Quill, M.D. has written an editorial for the New England Journal of Medicine that addresses the medical and legal issues in this case quite nicely. Although I disagree with him when he says, [T]he courts-- though their involvement is sometimes necessary-- are the last place one wants to be when working through these complex dilemmas," (the courts are exactly where this sort of thing should be dealt with, doctor-- not dealing with this case in the courts is why this case is a crisis), Dr. Quill's medical impressions strike me as careful, intelligent, and worthy of respect. Indeed, it is the respect that the courts have shown to the medical opinions of other experts that demonstrates why the system we have for these types of decisions works-- and why the different treatment this case is receiving is a travesty. (Via rc3.)

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